Background The recent marketing of new high-cost antifungal agents (echinocandins and azoles) requires the design of cost-effective treatment protocols. Purpose A new treatment guide for candidaemia and other invasive fungal infections for non-haematology adult patients was approved in June 2011. The main objective was to evaluate the cost reduction by introducing this protocol in a 737-bed University Hospital serving a population of more than 400,000 inhabitants. Materials and Methods Retrospective observational study between June and December 2011. We reviewed the medical records of patients whom were prescribed antifungal treatment during that time and we assessed the adjustment to the approved treatment guidelines. To quantify the avoided costs we extracted consumption data and costs of antifungals from the pharmacy service management system (SAP®) and compared them with the same period the previous year. Results During the study 43 non-haematology patients were treated with antifungal agents. In 38 patients (88.4%) the approved treatment guidelines were followed and in 5 patients (11.6%) they were breached.The most significant breaches occurred in internal medicine (22.2%) and in critical care (3.7%). Regarding avoided costs for the six months of the study, antifungal costs were reduced by 240,616 euros. We observed a 61.9% and 48% increase in use in fluconazole and anidulafungin, and a 42.8% and 41.7% decrease in caspofungin and liposomal amphotericin B use. These results are consistent with the recommendations contained in the guide (first line use of fluconazole in non-immunosuppressed patients and in azole resistance use anidulafungin). Micafungin use was restricted to the paediatric population with consumption equal to that in the previous period. Conclusions The treatment guideline compliance was excellent at our hospital, resulting in a significant decrease in antifungal expenses. Implementation of these guidelines in the management of high-cost drugs resulted in significant cost reductions and therefore in a more rational use of healthcare budgets. No conflict of interest.

BackgroundTeriflunomide is an immunomodulatory agent with anti-inflammatory properties that inhibits the mitochondrial enzyme dehidroorotato-dehydrogenase (DHO-DH), which is required for the synthesis of pyrimidine, blocking the proliferation of activated B and T lymphocytes. It is believed that the therapeutic effect is related to the reduction in the number of lymphocytes. It is indicated for the treatment of adult patients with relapsing-remitting multiple sclerosis with the advantage of oral administration.PurposeTo analyse the use of teriflunomide in patients diagnosed with multiple sclerosis.Material and methodsA retrospective observational study from January 2013 to May 2015. We used the SAP program to evaluate the clinical history and dispensations of patients treated with teriflunomide. The following data were recorded: sex, age, EDSS, previous treatments, control of liver enzymes, kidney function, blood pressure and pregnancy test.Results18 patients, 17 women and 1 man, were evaluated, with an average age of 41.11 years (range 23–79). Mean EDSS was 1.85 (1–5). All patients had recorded blood pressure, blood count, and kidney and liver function approximately every 2 weeks.Teriflunomide was prescribed as the firstline treatment in 5 patients (27.77%), as secondline in 3 patients (16.66%), as the third treatment in 8 patients (44.44%), and as the fourth and fifth treatments, respectively, in 1 patient (5.55%). Two patients began it before marketing.The immediately preceding treatment was glatiramer acetate in 5 patients, dimethyl fumarate in 1, interferon beta 1a 44 µg in 5 and interferon beta-1a 30 µg in 2 patients. The reasons for the change were cutaneous adverse effects on local reaction at the injection site in all cases except for dimethyl fumarate (digestive intolerance).The average duration of treatment with teriflunomide was 3.77 months (1–20), without any abandonment of treatment by that time.ConclusionWhile reports of teriflunomide therapeutic positioning is indicated at the forefront of relapsing-remitting multiple sclerosis, only 29.41% of our patients were prescribed this as the first choice. In the future, more patients may start teriflunomide as the firstline treatment given the comfort of the route of administration and good tolerance. Due to the short time to market, a longer term review is needed to verify the response to the drug.References and/or Acknowledgements No conflict of interest.

Background Daptomycin is an antibiotic only active against Gram-positive bacteria, with rapid bactericidal activity, a concentration-dependent and post-antibiotic effect. Indicated for complicated skin or soft tissue infections in adults (cSSTI), right side endocarditis due to Staphylococcus aureus and S. aureus bacteraemia associated with right-side infective endocarditis. Abstract DGI-062 Table 1 ECOG No. metastatic sites Line number Median TT (w) 0 1 2 No data 1 2 3 Common sites 1 ≥2 SORAFENIB 3/5 2/5 2/5 3/5 40% Lung 40% Bones 4/5 1/5 5 (IQR: 2–49.5) SUNITINIB 7/13 3/13 1/13 2/13 6/13 6/13 1/13 53.85% Lung 30.77% Liver 11/13 2/13 48 (IQR: 16.5–80.5) EVEROLIMUS 1/4 3/4 2/4 1/4 1/4 50% Liver 0/4 4/4 10 (IQR: 8–12) Purpose To perform a retrospective observational study of the use and effectiveness of daptomycin in our hospital. Materials and Methods We extracted from the hospital computer system (SAP) prescribing data about daptomycin from January to December 2011. The data collected included age, sex, history number, diagnosis, causative organism, prescriber service, treatment duration and reason for suspension. ResultsWere treated 85 patients (69% male) with an average age of 63.3 years (range 22–86 years). The average duration of treatment was 20.5 days. Prescribers’ services were: cardiac surgery/cardiology (27%), UCI (15%), haematology (12%), internal medicine (12%), nephrology (12%) and others (22%). The diagnoses for which daptomycin was used were: 32% endocarditis, 32% cSSTI, 20% bacteraemia, 11% osteoarticular infection and 5% others. Microorganisms identified were: 11% methicillin-resistant S. aureus (MRSA), 20% coagulase-negative Staphylococcus, 5% others and 64% was empirical treatment. In 36.5% of prescriptions, daptomycin was used as second-line antibiotic treatment, either because the patient did not respond to previous antibiotic treatment (32%) or due to side effects (39% anaemia with linezolid and 29% renal damage with vancomycin). The reasons for suspending daptomycin were: 77% for improvement/patient discharge or who ended treatment or switched to oral treatment, 9% change in treatment and 14% deceased. Conclusions In 84% of cases the prescription complied with the authorised indications in datasheet. Daptomycin was prescribed first-choice in 63.5% of treatments. In 64% of case treatment was empirical without subsequent confirmation of the causative organism. It is necessary to establish a mechanism to decrease the rate of use of this antibiotic in the hospital for frontline empirical treatments. No conflict of interest.

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treatment was temporarily suspended due to decreased haemoglobin and three (37.5%) had adverse effects (nausea, vomiting, stomach pain) without interruption of treatment.Niraparib: four (36.4%) patients started with 300 mg and seven (63.6%) 200 mg. Five (45.5%) patients needed dose reduction, two with initial dose 300 mg and three 200 mg: three of them continued (one of 300 mg and two of 200 mg initial dose). In five (45.5%) patients, treatment was discontinued, two (40%) due to adverse effects (neutropaenia, thrombocytopaenia and increased creatinine respectively) and three due to progression (60%), in addition temporarily suspending it due to neutropaenia. Six continued (three with 200 mg and three with 100 mg) and three of them had to temporarily interrupt it due to thrombocytopaenia. Conclusion In both treatments, the haematological adverse effects are more severe, frequent and worse tolerated in the case of Niraparib than Olaparib. In addition, greater discontinuity of treatment is observed in patients with Niraparib.